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Counseling Services

Individual
Couples & Family
Relationship Issues
Grief and Loss
Anxiety and Fears
Depression
Personal Growth
Parenting Support
Stress Management
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Helpful Forms

If you're a new client, please complete the following form and bring them to your first therapy session.You will also need a copy of your insurance card and your primary care physician's name, address, phone number, and fax number. It always helps the process if you have already discussed with your doctor that you will be seeking counseling services with us. Otherwise, they may not authorize the use of your insurance policy to pay for services rendered.

userfiles/3642617/file/Referral form.pdf


If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

userfiles/3642617/file/Authorization form.pdf



Note: To download Adobe Acrobat Reader for free,
click here.


We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

Please don't put anything here:
Please enter the words below: Click to reload image What is this?


By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.

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Helpful Forms

Click here to view and print forms for your appointment.

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